Trauma Flashcards
1
Q
[…] third humeral shaft fractures are felt to have higher rates of nonunion
A
Proximal
2
Q
[…] interposition in proximal diaphyseal fractures may lead nonunion
A
Biceps tendon
3
Q
Radiocapitellar joint is essential to longitudinal and […] stability of the elbow
A
valgus
4
Q
TEA is indicated in unreconstructable capitellar fractures in elderly patients with associated […] column instability
A
medial
5
Q
In fixation of capitellum fracture, avoid disruption of the blood supply that comes from the […] aspect of the elbow
A
posterolateral
6
Q
What is the most common complication following a capitellum fracture?
A
stiffness
7
Q
On average, the bare area of the olecranon is located […] cm from the tip of the olecranon.
A
2
8
Q
Bicolumnar parallel plating of distal humerus fractures has been found to have […] biomechanical strength and rigidity compared to orthogonal plating.
A
greater (but remember - no clinical difference between plating techniques)
9
Q
The distal radius is responsible for […] percent of axial load
A
80
10
Q
What bones does the distal radius articulate with?
A
scaphoid, lunate, ulna
11
Q
The […] ligament prevents ulnar translation of the carpus.
A
radioscaphocapitate
12
Q
Which column transmits load from the carpus to the forearm?
A
intermediate column (lunate)
13
Q
Lister’s tubercle is approximately […] proximal to articular surface
A
1 cm
14
Q
Distal radius fractures with less than […] radial shortening can be treated non-operatively.
A
5 mm
15
Q
Distal radius fractures with dorsal angulation less than […] deg or within […] deg of contralateral distal radius
A
5 deg; 20 deg
16
Q
Failure to address the volar ulnar corner in distal radius fractures can result in […]
A
volar carpal subluxation
17
Q
In LaFontaine’s predictor of instability, […] is the most predictive of instability, followed by […]
A
radial shortening; dorsal comminution
18
Q
In LaFontaine’s criteria, initial displacement greater than […] is a predictor of instability.
A
1 cm
19
Q
In LaFontaine’s criteria, initial radial shortening […] is a predictor of instability.
A
> 5mm
20
Q
In distal radius fractures, there is a higher loss of reduction with […] or more of LaFontaine criteria
A
3
21
Q
Rupture of which tendon is associated with the treatment of closed reduction and casting for distal radius fractures?
A
EPL
22
Q
Which nerve can be injured with the Kapandji technique?
A
radial sensory nerve injury
23
Q
Rupture of […] tendon is most common with volar plates in distal radius fractures.
A
FPL
24
Q
Which sensory nerve can be injured with volar plating of distal radius fractures due to retraction of tendons?
A
palmar cutaneous branch of the median nerve
25
Nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the [...] tendon
EPL
26
What is the treatment for EPL rupture following a distal radius fracture?
EIP to EPL transfer
27
90% young adults with distal radius fractures will develop symptomatic arthrosis if articular stepoff is greater than [...]
1-2 mm
28
extra-articular angulation malunion of a distal radius fracture with dorsal angulation greater than [...] deg from neutral results in increased stiffness of the interosseous membrane and limitation of simulated forearm pronation and supination
10
29
The forearm interosseous membrane distal fibers have the most tension in [...]
supination
30
The forearm interosseous membrane central fibers are under the most tension in [...]
neutral position
31
The [...] is key portion of the forearm IOM to be reconstructed.
central band
32
The median nerve runs with the brachial artery and then courses between the heads of the [...] muscle.
pronator teres
33
The median nerve courses between [...] and [...] in the forearm until the carpal tunnel.
the FDS and FDP
34
The brachial artery branches into the radial and ulnar arteries [...] past the elbow joint
1 cm
35
In adult BBFF treated non-op, loss of greater than [...] deg of rotation in 30% of patients
50
36
What is the most important variable for functional outcome of adult BBFF?
restore the radial bow
37
Foream ex fix pin diameter should not exceed [...]
4 mm
38
ORIF of adult BBFF should be non-weightbearing for [...] weeks post op
6
39
In adult BBFF, plates should not be removed less than [...] from implantation due to risk of re-fracture.
1 year
40
In order to prevent refracture after HWR in an adult BBFF, wear functional forearm brace for [...] weeks and protect activity for [...] months after plate removal
6; 3
41
What percentage of grip strength loss can be expected following an adult BBFF?
25%
42
The shuck test is performed after fixation of the distal radius to assess the status of the DRUJ, namely the [...] ligaments of the TFCC.
radioulnar
43
You are treating a comminuted, apex-volar angulated distal radius fracture with an external fixator. Tightening the fixator with volar translation of the lunate will:
restore volar tilt
44
To gain exposure to the proximal radius in a classic volar Henry approach, the radial artery is retracted [...] and the supinator muscle should be elevated and retracted [...] with the forearm in [...]
medially; laterally; supination
45
The [...] pelvic ligaments resist shear and flexion
sacrotuberous
46
L5 nerve root exits below L5 TP a courses over sacral ala [...] cm medial to the SI joint.
2
47
The internal iliac artery dives posteriorly near SI joint and divides in the posterior division giving off [...] artery and anterior division becoming [...] artery
superior gluteal; obturator
48
The corona mortis is a connection between the [...] and [...].
obturator and and external iliac systems
49
AIIS pins can place the [...] nerve at risk
lateral femoral cutaneous
50
[...] is the most common urogenital injury with pelvic ring fracture
Posterior urethral tear
51
Which zone of sacral fractures have the highest rate of neurologic deficit (60%)?
Zone 3
52
Which sacral ligaments are intact in an APC-II pattern?
Posterior sacroiliac ligaments; (note: anterior, sacrospinous, and sacrotuberous are all disrupted)
53
Of the pelvic ring injuries, [...] have the highest rate of mortality, blood loss, and need for transfusion.
APC-III
54
Which pelvic ring injury has the highest rate of head injury?
LC injuries; LC-III the highest
55
Which nerve roots innervate tibialis anterior?
L4 and L5
56
Nerve palsy most commonly affects [...] acetabulum fracture patterns.
transverse + posterior wall
57
The acetabular roof arc angle to determine acetabular fracture stability is defined as less than [...] deg on AP, obturator and iliac oblique views
45
58
The gull sign is pathognomic for [...] acetabular fractures.
posterior wall
59
The gull sign seen in posterior wall acetabulum fractures represents impaction of [...] of the acetabulum.
superomedial roof
60
The gull sign is best seen on the [...] radiographic view.
iliac oblique
61
The spur sign is pathognomonic for [...] type acetabular fractures.
associated both column
62
The spur sign represents the most caudal part of intact [...] due to medialization of acetabular articular components.
ilium
63
The spur sign is best visualized on [...] acetabular radiographic views.
obturator oblique
64
Acetabulum fractures with associated hip dislocations should be reduced within [...] hours for improved outcomes
12
65
There are worse outcomes in acetabulum fractures with fixation of fracture greater than [...] weeks from time of injury
3
66
Patients undergoing acute THA for acetabulum column fractures should have a [...] construct.
cage and cup
67
In perc fixation of acetabulum fractures, [...] is the best view to rule out joint penetration.
obturator outlet
68
In perc fixation of acetabulum fractures, [...] view is the best to determine anteroposterior position of screw within the pubic ramus.
iliac inlet
69
In perc fixation of the acetabulum, [...] view is best to determine position of a supraacetabular screw within tables of the ilium
obturator inlet
70
What is the most common complication following acetabulum fractures?
DJD
71
[...] percent survival noted at 20 years for patients s/p ORIF of acetabulum
80
72
What two acetabulum fracture patterns have higher incidence of DJD?
T-type and **transverse posterior wall**
73
Age greater than [...] is a risk factor for DJD following acetabulum fractures.
40
74
Which acetabulum approach has the lowest incidence of heterotopic ossification?
ilioinguinal
75
The [...] view allows for the best evaluation of hip joint stability during examination for posterior wall acetabulum fractures.
obturator oblique
76
The incidence of sciatic nerve palsy following a traumatic hip dislocation is roughly [...] percent.
10
77
The posterior wall of the acetabulum is best visualized on which radiographic view?
Obturator oblique
78
The [...] view will best show the the anterior-posterior placement of an anterior column ramus screw.
iliac oblique inlet
79
What is the interval of the Watson-Jones (anterolateral) hip approach?
Gluteus medius; TFL
80
The proximal extension of the Watson-Jones (anterolateral) approach is limited by the [...] nerve and vessels
superior gluteal
81
The dislocation rate of a THA is about [...] times higher than hemiarthroplasty for a femoral neck fracture.
5-7
82
Sliding hip screw has lower reoperation rates compared to cannulated screws in which groups?
displaced femoral neck fractures; basicervical femoral neck fractures, current smokers
83
Orthopaedic geriatric co-management of trauma patients has been demonstrated to yield [...] mortality
decreased
84
Orthopaedic geriatric co-management of trauma patients has been demonstrated to yield [...] time to surgery.
decreased
85
Orthopaedic geriatric co-management of trauma patients has been demonstrated to yield [...] hospital length of stay.
decreased
86
Orthopaedic geriatric co-management of trauma patients has been demonstrated to yield [...] post - operative complications.
decreased
87
Orthopaedic geriatric co-management of trauma patients has been demonstrated to yield [...] post-operative mobility at 4 months
improved
88
Persistent use of ambulatory aids is predicted if TUG > [...] seconds
26
89
What is the mortality rate of a femoral neck insufficiency fracture at one year?
25-30%
90
Short cephalomedullary nail can tolerate up to [...] cm of subtrochanteric extension
3-4
91
helical blade constructs have much higher rates of cut-[...] when compared to lag screw constructs.
through (ie central perforation through head)
92
Cut-out defined as [...] perforation of the femoral head by the blade/screw with subsequent varus collapse.
anterocranial
93
Cut-through defined as [...] perforation of the femoral head by the blade/screw without subsequent collapse
central
94
4 hole SHS plates show [...] benefit clinically and biomechanically over 2 hole plates.
no
95
SHS have [...] EBL compared to CMN.
increased
96
Implant failure or cut out for IT fractures usually occurs within first [...] months
4
97
TAD greater than [...] mm is associated with 60% failure rate
45
98
The most frequent intraoperative complication with antegrade nailing of a subtrochanteric femur fracture is [...] and [...] malreduction
varus; procurvatum
99
Bisphosphonates inhibit [...] bone healing
primary/intramembranous (questionable card, but something to think about)
100
The most common deformity after antegrade nailing of a subtrochanteric femur fracture is [...] and [...]
varus; procurvatum
101
The use of a sliding hip screw in basicervical fracture patterns in patients that are current smokers has been associated with [...] reoperation rates compared to multiple cannulated screws (MCS).
decreased
102
Fracture of the [...] femoral condyle is more common in a Hoffa fracture.
Lateral
103
The [...] femoral condyle is the more common condyle fractured in a Hoffa fracture.
lateral
104
Locking plates for distal femur fractures allows better control of [...] plane compared to 95º angled blade plate and dynamic condylar screw
coronal
105
Insertion of a retrograde femoral IMN requires greater than/equal to [...] knee flexion
70 deg
106
Most important blood supply to the patella is located at the [...] pole
inferior
107
In patella fractures, an articular step-off greater than [...] mm or displaced fracture gap greater than [...] mm dictate operative management
2-3; 3
108
What is the most common complication following patella ORIF?
symptomatic hardware
109
Which patella ORIF construct has the highest rates of symptomatic hardward?
tension band using K-wires
110
Blood loss in closed femoral shaft fractures is [...]
1-1.5 L
111
In a femoral shaft fracture, what radiograph is used for iipsilateral femoral neck rule-out protocol?
dedicated 10° internal rotation AP hip radiographs
112
The CT capsular sign for ipsilateral femoral neck fractures is defined as a difference of greater than [...] mm capsular distension between injured and uninjured sides on the axial soft tissue window
1
113
With adequate resuscitation, IL-6 should be less than [...]
500 pg/dL
114
Reamed femoral nailing compared to unreamed nailing results in [...] union rates.
increased; ie reaming is superior
115
Reamed femoral nailing compared to unreamed nailing results in [...] time to union.
decreased
116
A larger femoral nail is stiffer and is related to the diameter to the [...]th power
4
117
A larger femoral nail is stiffer and is related to the [...] to the 4th power
diameter
118
In femoral nailing, use of a fracture table increases risk of [...] rotation deformities when compared to manual traction.
internal
119
Shortening along the anatomical axis of the femur leads to [...] MAD
medial
120
Lengthening along the anatomical axis of the femur leads to [...] MAD
lateral
121
The most common variation of a Hoffa fracture is a coronal fracture of the [...] femoral condyle.
lateral
122
Popliteal artery injuries occur often due to tethering at the popliteal fossa proximal - fibrous tunnel at the [...], distal - fibrous tunnel at [...] muscle
adductor hiatus; soleus
123
Anterior knee dislocation injures what ligament of the knee?
PCL
124
[...] knee dislocations have the highest rate of common peroneal nerve injury.
Anterior
125
[...] knee dislocations have the highest rate of complete popliteal artery injury.
Posterior
126
Acute (< 3 weeks) ligamentous knee reconstruction following a knee dislocation is associated with a [...] incidence of residual instability and stiffness that is resistant to nonoperative interventions
higher
127
Lateral meniscus tears are associated with Schatzker [...] TPFs.
II
128
Which meniscus is more commonly torn in tibial plateau fractures?
Lateral
129
Medial meniscus tears are more common in Schatzker [...] tibial plateau fractures.
IV
130
Lateral meniscus tears in a tibial plateau fractures are associated with greater than [...] mm articular depression
10
131
Lateral meniscus tears in a tibial plateau fracture are associated with greater than [...] mm condylar widening
6
132
ACL injuries are more common in which Schatzker types?
IV and VI
133
The medial meniscus is less mobile due to [...] ligaments
coronary
134
Tibia [...] rotates with knee extension
externally
135
Tibia externally rotates with knee [...]
extension
136
Articular step-off greater than [...] mm is an indication for ORIF of a tibia plateau.
3
137
Condylar widening of greater than [...] mm is an indication for ORIF of a tibia plateau fracture.
5
138
ORIF of a tibia plateau fracture has worse clinical outcomes with alteration of limb mechanical axis > [...] degrees
5
139
In use of ring fixators for tibial plateau fractures, small wires must be kept at least [...] mm from the joint to avoid septic joint.
15
140
What is the interval of a posteromedial approach to a tibia plateau?
pes and medial gastroc head
141
Which bone graft substitute has the highest compressive strength for filling metaphyseal voids in tibial plateau fractures?
calcium phosphate cement
142
Calcium phosphate has [...] subsidence compared with autograft in filling metaphyseal bone defects.
lower
143
What has the highest impact on need for amputation in a tibial shaft fracture?
Severity of muscle injury
144
Indication for non-operative management of tibial shaft fractures is less than [...] deg of varus and valgus.
5
145
Indication for non-operative treatment of tibial shaft fractures is less than [...] cm of shortening.
1
146
Indication for for non-operative treatment of tibial shaft fractures is less than [...] deg of flexion/extension.
10
147
The most common malunion for proximal third tibial shaft fractures is [...] and [...].
valgus and procurvatum
148
Lateral plating for proximal third tibial shaft fractures with medial comminution can lead to [...] collapse
varus
149
In proximal third tibia fractures, blocking screws placed in metaphyseal segment should be on the [...] side of the deformity.
concave
150
To prevent valgus in a proximal third tibial shaft fracture, a blocking screw should be placed [...] in the proximal/metaphyseal fragment.
laterally
151
To prevent procurvatum in proximal third tibial shaft fractures, a blocking screw should be placed [...] in the proximal/metaphyseal fragment.
posteriorly
152
There is risk of [...] malunion with midshaft tibia fractures and an intact fibula.
varus
153
There is increased [...] and [...] malunion seen with IMN compared to plate osteosynthesis in fixation of pilon fractures.
valgus; recurvatum
154
In pilon fractures, clinical improvement seen for up to [...] years after injury
2
155
The anterior tibial artery and deep peroneal nerve course over anterior ankle between which tendons?
EDL and EHL
156
Medial clear space of greater than [...] with external rotation stress applied to a dorsiflexed ankle is predictive of deep deltoid disruption
5 mm
157
Instability of the ankle syndesmosis is greatest in the [...] direction
anterior-posterior
158
What is the dominant blood supply to the talus body?
posterior tibial artery via artery of tarsal canal
159
What radiographic view is the best view to demonstrate talar neck fractures?
Canale view
160
[...] subtalar dislocations more likely to be open.
Lateral
161
A cuboid fracture is more commonly associated with a [...] subtalar dislocation.
lateral
162
A fibula fracture is more commonly associated with a [...] subtalar dislocation.
lateral
163
An anterior calcaneus fracture is more commonly associated with a [...] subtalar dislocation.
lateral
164
A lateral process of the talus fracture is more commonly associated with a [...] subtalar dislocation.
lateral
165
A posterior process fracture of the talus is more commonly associated with a [...] subtalar dislocation.
medial
166
A navicular fracture is more commonly associated with a [...] subtalar dislocation.
medial
167
The posterior process of the talus consists of medial and lateral tubercles separated by groove for the [...] tendon.
FHL
168
Is a medial or lateral subtalar dislocation more common?
medial
169
A medial subtalar reduction can be blocked by what tendons?
peroneal tendons and EDB
170
Does the foot become locked in supination or pronation in a medial subtalar dislocation?
supination
171
In a lateral subtalar dislocation, which tendons can block reduction?
PT, FHL, FDL
172
What is the most common complication following a subtalar dislocation?
Stiffness
173
Do medial or lateral subtalar dislocations have poorer outcomes?
lateral (associated with higher energy)
174
A fracture of the anterior process of the calcaneus is caused by avulsion of which ligament?
bifurcate ligament
175
The flexor hallucis longus tendon is [...] and [...] to the posterior facet of the calcaneus.
medial and inferior
176
The sustentaculum tali is contained in the anteromedial fragment of the calcaneus, which remains "constant" due to [...] and [...] ligaments
medial talocalcaneal; interosseous
177
What is a normal Bohler's angle?
20 - 40 deg
178
What is a normal angle of Gissane?
120-145 deg
179
Anterior process calcaneal fractures with greater than [...] percent involvement of calcaneocuboid joint is an indication for ORIF.
25
180
Age greater than [...] is associated with a poorer outcome of ORIF of calcaneal fractures.
50
181
Which lateral approach to the calcaneus has a lower incidence of sural nerve neuralgia?
Sinus tarsi approach
182
In a sinus tarsi approach the incision made in line with the tip of the fibula and the base of the [...]th metatarsal
4th
183
In a sinus tarsi approach, [...] is retracted cephalad to expose sinus tarsi and posterior facet.
extensor digitorum brevis
184
What is the most common complication following a talar neck fracture?
post-traumatic arthritis (sub-talar being the most common)
185
Administration of [...] at the time of definitive fixation has been shown to decrease the need for subsequent bone grafting procedures in Gustilo-Anderson type IIIA and IIIB open tibia fractures.
rhBMP-2
186
Appropriate braking time returns at a point [...] weeks after initiation of weightbearing after treatment of lower extremity long bone and periarticular fractures
6
187
What is a normal talocrural angle?
83 deg +/- 4
